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    Assessment in Mixed Pain Dr. Yudiyanta, SPS (K)

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    melmartana
    This document contains the curriculum vitae of Yudiyanta. It lists his educational background and professional experience. He received his medical degree from the Faculty of Medicine at Gadjah Mada University in 1998 and works as a neurologist and pain consultant at Sardjito Hospital. He specializes in pain and headache and serves as the Chief of the Pain Study Group in Jogjakarta.

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    Assessment in Mixed Pain Dr. Yudiyanta, SPS (K)

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    melmartana
    544 views26 pages
    This document contains the curriculum vitae of Yudiyanta. It lists his educational background and professional experience. He received his medical degree from the Faculty of Medicine at Gadjah Mada University in 1998 and works as a neurologist and pain consultant at Sardjito Hospital. He specializes in pain and headache and serves as the Chief of the Pain Study Group in Jogjakarta.

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    Mixed Pain

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    Assessment in Mixed Pain Dr. Yudiyanta, SpS(K)

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    This document contains the curriculum vitae of Yudiyanta. It lists his educational background and professional experience. He received his medical degree from the Faculty of Medicine at Gadjah Mada University in 1998 and works as a neurologist and pain consultant at Sardjito Hospital. He specializes in pain and headache and serves as the Chief of the Pain Study Group in Jogjakarta.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    544 views26 pages

    Assessment in Mixed Pain Dr. Yudiyanta, SPS (K)

    Uploaded by

    melmartana
    This document contains the curriculum vitae of Yudiyanta. It lists his educational background and professional experience. He received his medical degree from the Faculty of Medicine at Gadjah Mada University in 1998 and works as a neurologist and pain consultant at Sardjito Hospital. He specializes in pain and headache and serves as the Chief of the Pain Study Group in Jogjakarta.

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    CV

    • Name : YUDIYANTA
    • Adress: Jl Rajawali Raya 45 C Condong Catur Depok Sleman
    • Staff in Neurology Dept. Faculty of Medicine, Gadjah Mada University –
    Sardjito Hospital Jogjakarta in:
    – Pain Division
    – Neurophysiology-Neuromuscular Division
    • Chief of Pain Study Group, Perdossi Chapter Jogjakarta
    • Vice of Pain Team-Pain Clinic in Sardjito Hospital
    • Sub Specialization: Pain and Headache Consultant, 2013
    • Neurologist, 2006 Neurology Department, Faculty of Medicine, University
    of Gadjah Mada, Jogjakarta
    • FMD: Faculty of Medicine UGM, 1998
    ASSESSMENT in MIXED PAIN

    Yudiyanta
    Neurology Dept. Faculty of Medicine UGM/
    RSUP Dr Sardjito
    Curriculum Vitae
    • Name : YUDIYANTA
    • Adress: Jl Rajawali Raya 45 C Condong Catur Depok Sleman
    • Staff in Neurology Dept. Faculty of Medicine, Gadjah Mada University –Sardjito
    Hospital Jogjakarta in:
    – Pain Division
    – Neurophysiology-Neuromuscular Division
    • Chief of Pain Study Group, Perdossi Chapter Jogjakarta
    • Vice of Pain Team-Pain Clinic in Sardjito Hospital
    • Sub Specialization: Pain and Headache Consultant, 2013
    • Neurologist, 2006 Neurology Department, Faculty of Medicine, University of Gadjah
    Mada, Jogjakarta
    • FMD: Faculty of Medicine UGM, 1998
    Undertreated Pain vs Over-Prescribing
    Contributing Factors

    •Lack of knowledge among prescribers about :


    – Philosophy of pain
    – Pathophysiology
    – Assessment of Pain
    – Current pain management guidelines/Treatment
    modality,
    – Risk management practices/ Comorbidity and side effect
    – Research in pain medicine
    – Management value and expectations.
    TYPE OF PAIN

    Superficial Somatic Pain


    Somatic
    Nocicepthic Deep Somatic Pain
    Visceral

    Peripheral NP

    Central NP
    TYPES OF PAIN Neuropathic

    SMP
    Central Sensitization
    Syndrome: FM
    MFPS etc
    Dysfunctional
    Psychiatric Dis.
    Somatoform etc (Idiopatik)
    Mixed Pain
    • Most pain is mixed
    • Even “nociceptive pain” can lead to central sensitization
    – Eg, osteoarthritis
    • fMRI and PET changes
    – Increased activation in brain areas involved with affect, aversive
    conditioning and motivation than experimental pain
    • These patients display hyperalgesia locally and in areas distant
    from the arthritic joint
    – After THA, these patients display reduced pain in both areas

    • ALL pain has a psychological component!


    Aranda-Villalobos P et al. Arthritis & Rheumatism 2013; 65: 1262-1270.
    Sofat et al. Rheumatology 2011; 50: 2157-2165
    Mixed Pain
    • Cancer pain,
    • Back Pain with Radicular,
    • CTS,
    • Cervicogenic Headache/occipital neuralgia
    • Migraine headaches
    • Osteoartritis
    • Piriformis syndrome
    • TMJ Disorder
    • etc
    Definitions of Mixed Pain
    • There are no clear guidelines for diagnosing mixed pain as a
    syndrome

    • In the case of mixed pain syndromes, healthcare professionals are


    likely to hear elements of both neuropathic and nociceptive pain
    described by the patient (Ritchie, 2010)

    • So it seems reasonable to combine the diagnosis and management


    of the two components in this case.

    • The problem once having diagnosed their patient’s pain is to decide


    whether there is a neuropathic component to the pain or not
    Pain

    Assessment of Disease Assessment of Pain

    Diagnosis of Disease Diagnosis of Pain

    Management of Disease Management of Pain


    Pain

    Assessment of Disease Assessment of Pain

    Nociceptic Pain Neuropathic Pain Disfunctional Pain

    Mixed Pain

    Pain Intensity Comorbidity & Side Effects

    Treatment
    Nocicepthic

    Somatic Visceral

    • Well localized • Diffuse and poorly localized


    • Intermittent or constant • Intermittent or constant
    • “aching,” “stabbing,” • “dull,” “colicky,” “squeezing”
    “gnawing,” “throbbing” • Refers to other locations.
    • Accompanied by motor and
    autonomic reflexes (Eg, nausea,
    vomiting, muscle tension, etc)
    Neuropathic Pain

    Peripherally Centrally Sympathetically


    generated pain generated pain maintained pain

    • may be generated peripherally or centrally


    • characterized by localized autonomic
    dysregulation
    • vasomotor or sudomotor changes, edema,
    sweating, trophic changes, including
    atrophy (ex: CRPS )
    Neuropathic Pain
    1.Possible neurophatic pain : Riwayat perjalanan penyakit pasien
    merupakan lesi atau penyakit yang relevan menimbulkan gejala nyeri dan
    sesuai dengan distribusi neuroanatomi saraf yang terkena
    2.Probable neurophatic pain : mencakup kriteria possible dan salah satu
    temuan :
    1. Konfirmasi tes diagnostik adanya lesi neuropati
    2. Ditemukan gejala sensorik negatif atau sensorik positif sesuai area
    neuroanatomi
    3.Definite neurophatic pain : kriteria possible dan probable (Haanpaa M., Attal N.,

    Backonja M., et al. NeuPSIG guidelines on neuropathic pain assessment. Pain 2011;152:14-27)

    • Anamnesis + Pemeriksaan fisik neurologik bedside adalah satu-


    satunya cara menentukan gejala nyeri neuropatik dari nyeri non-
    neuropatik
    Penilaian Objektif Nyeri Nuropatik
    1. Tes diagnostik laboratorium
    2. Tes kuantitatif sensorik
    3. Pemeriksaan fisik bedside.
    4. Istrumen penapisan kuesioner nyeri neuropatik
    Serabut Saraf Sensorik Pemeriksaan Objectif
    Klinis Tes Kuantitatif Laboratorium
    Ab sentuh Kapas Halus VonFrey NCS, SEPs
    Filaments
    Ad Getar, Pinprick, Garputala, Vibrator NCS, SEPs, LEPs
    Nyeri tajam Wooden
    Cocktail Stick
    C Dingin, Thermoroller Thermode NA
    Panas, Thermoroller Thermode LEPs
    Terbakar NA Thermode LEPs

    Gruccu et al., Tools for Assasing Neuropathic Pain, Medicine, 2009


    SMP
    NEUROPATHIC PAIN
    Perbandingan Ketepatan Kuesioner Penapisan Nyeri Neuropatik
    NEUROPATHIC PAIN

    1. Pin Pricks
    2. Electric Shock Like
    3. Burning/Hot INTENSITY
    4. Numbness
    5. Alodinia

    Gruccu G & Truini A, Tools for Assessing Neuropathic Pain, Plos Medicine, 2009
    1. Burning
    2. Pricking
    3. Light Touch Allodinia
    4. Electricshock like
    5. Heat Allodinia
    6. Numbness <13 13-18 > 18
    7. Mecanical Allodinia
    Margreta et.al., 2014
    PAIN INTENSITY

    ACUTE PAIN CHRONIC PAIN


    (<3 Mo) (> 3 Mo)

    Multi-Dimensional Scale

    Uni-Dimensional Scale McGill Pain Questionnaire (MPQ)


    The Brief Pain Inventory (BPI)
    The Memorial Pain Assessment Card
    * Tools pengkajian nyeri
    1.Numeric Rating Pain Scale/VAS/VRS

    2.Wong Baker Faces

    3. NIPS Pain Scale

    4.FLACC Pain Scale

    5.COMFORT Pain Scale

    10/15/2017
    COMORBIDITY & Side Effects

    Gastrointestine

    Cardiac
    Vascular Brain
    COMORBIDITY Peripheral

    Renal

    Respiratory

    Contraindication And Side Effect


    Assessment of Pain

    Management of Pain

    Neurorestoration in Pain

    Neuro- Neuro- Neuro Neuro Neuro


    Regeneration Repair Plasticity Modulation Rehabilitation

    Self Restoring Pain Non Self Restoring Pain?


    ASSESSMENT IN MIXED PAIN

    Nociceptic

    TYPE OF PAIN Neuropathic

    Dysfunctional

    PAIN INTENSITY OF PAIN

    COMORBIDITY & SIDE EFFECT

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